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Ashwood, Neil
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Biography
I am an Orthopaedic Consultant with over 20 years of surgical experience. I qualified in London at University College Hospital and the Middlesex in 1992. I did my registrar training on the North West Thames rotation and subspecialised in Upper Limb Surgery undertaking a British Orthopaedic Association approved fellowship with Professor Greg Bain in Adelaide. I have undertaken some work in disaster areas during my training including Azerbaijan. I was appointed Honorary Professor of Trauma and Orthopaedics at Wolverhampton University in March 2022. I have an interest in medical education with a Masters qualification from Warwick University. I am currently researching a wide range of topics in upper limb and trauma surgery looking at outcomes and ways to improve services. Collaborating with colleagues in Wolverhampton we are looking at the way technology can improve healthcare using deep learning and artificial intelligence for screening and diagnostics. I have published widely in the worldwide literature with over 100 articles cited within the literature. I have been Associate Medical Director and Surgical Tutor for the Royal College of Surgeons. I am an ATLS and Trace course instructor for the Royal College of Surgeons and have co-directed the ATLS course in Burton for the last 2 years. I am on the Treasurer of the British Association of Clinical Anatomists and support the continued training in basic sciences within medicine. I am happy to help colleagues with projects just email me.
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Publication Open Access Low energy fall with high impact consequences: a case report and biomechanical literature review of ogawa type I coracoid process avulsion fracture with acromioclavicular joint dislocation(Springer Nature, 2026-04-26) Ashwood, Neil; Rasul, Shahmeen; Danyowi, Saud; Leicester Medical School; University Hospitals of Derby and Burton NHS Foundation Trust; Trauma and Orthopaedics; Medical and Dental; Ashwood, Neil; Rasul, Shahmeen; Danyowi, SaudCoracoid process fractures are rare injuries, usually associated with high-energy trauma and disruption of the superior shoulder suspensory complex (SSSC). We report the case of a 36-year-old male who sustained an Ogawa type I coracoid avulsion fracture with concomitant acromioclavicular (AC) joint dislocation following a low-energy mechanical fall. Initial radiographs demonstrated AC joint displacement with an associated coracoid fragment, further characterised by computed tomography (CT) with three-dimensional reconstruction. Imaging confirmed a displaced basal fracture involving the coracoclavicular ligament origin, representing a biomechanically unstable double disruption of the SSSC. Operative management consisted of open reduction and internal fixation of the coracoid with a cannulated lag screw combined with AC joint stabilisation using a hook plate and supplementary suture fixation. This case highlights the importance of recognising occult instability in uncommon shoulder injuries, the role of advanced imaging in operative planning, and the need to restore both bony and ligamentous continuity to re-establish shoulder girdle stability.Publication Open Access Geometry driven fluid dynamics and cytocompatibility of 3D printed TPMS bone scaffolds(Elsevier, 2026-01-27) Ashwood, Neil; Arafat, Abul; Gupta, Abhishek; Arjunan, Arun; Baroutaji, Ahmad; Adebayo, David; Robinson, John; Appiah, Martin; Chameekara, T Wanniarachchi; Singh, Manpreet; Butcher, Kate; Vance, Aaron; University of Wolverhampton; University Hospitals of Derby and Burton NHS Foundation Trust; Prince Mohammad Bin Fahd University; Aston University; et al; Trauma and Orthopaedics; Medical and Dental; Arjunan, Arun; Ashwood, Neil; Vance, AaronTriply Periodic Minimal Surfaces (TPMS) can mimic the complex architecture of trabecular bone while facilitating controlled fluid transport and cellular colonisation. This study integrates computational fluid dynamics (CFD), laser powder bed fusion (L-PBF), and in vitro cell assays to evaluate the structure-function relationship of four Ti6Al4V TPMS scaffolds informed by Schwartz Primitive (SSC), Lidinoid (LSC), Gyroid (GSC), and Diamond (DSC) featuring 60% porosity. CFD simulations at inlet velocities ranging from 0.001 to 0.01 m/s revealed architecture-specific permeability ranging from 1.89 × 10 9 m2 (DSC) to 4.29 × 10 9 m2 (SSC) at low flow rates, with a consistent inverse relationship between flow velocity and permeability (R2 > 0.99). Mid-plane velocity fields highlighted scaffold-specific vortex formations and nutrient mixing dynamics, with SSC exhibiting pronounced swirling zones, promoting fluid homogenisation. In vitro cytocompatibility assessed via MTT assay on U-2OS osteosarcoma cells showed >85% viability across all geometries after 24 h and >88% after 7 days, with the LSC scaffold exhibiting the most consistent viability (101.8 ± 7.7%) and SSC showing significant improvement over time (87.2 ± 3.3% to 121.4 ± 6.2%, p < 0.015). Immunofluorescence imaging confirmed cell attachment across all architectures, with GSC and DSC supporting uniform cytoskeletal spreading and enhanced cell-pore integration. Degradation studies in PBS at 37 ◦C showed that DSC scaffolds underwent the highest mass loss (4.42% at day 7), correlating with their larger surface area, while pH monitoring suggested early ion release followed by buffering over time. These results demonstrate that scaffold topology significantly impacts permeability, degradation, and biological performance with SSC and GSC emerging as promising 3D printed microenvironments.Publication Open Access Axillary artery injury in proximal humeral fractures: displacement medial to the coracoid on x-ray as a risk sign of vascular injury(Springer Nature, 2026-03-11) Ashwood, Neil; Sayedahmed, Metwally; Bin Maidin, Muhammad; Dekker, Andrew; Tambe, Amol; University of Leicester; University Hospitals of Derby and Burton NHS Foundation Trust; Trauma and Orthopaedics; Medical and Dental; Ashwood, Neil; Sayedahmed, Metwally; Bin Maidin, Muhammed; Dekker, Andrew; Tambe, AmolAxillary artery injury is a rare but serious complication of proximal humeral fractures that can threaten both life and limb. The artery lies in close proximity to the glenoid and humerus, making it susceptible to laceration, thrombosis, or pseudoaneurysm during trauma or surgical fixation. Medial translation of the humeral shaft under the coracoid on a radiograph may help surgeons predict arterial injury and prepare accordingly. A retrospective review of cases in a large UK shoulder unit covering a million patients identified five cases over the last three years where proximal humeral fractures were complicated by vascular injury during surgery. The arterial injuries ranged from axillary artery tears with catastrophic bleeding, branch lacerations, and the formation of pseudoaneurysms. Treatment required vascular surgical repair of tears, bypass grafting, and embolization through interventional radiology for a pseudoaneurysm. While there was no loss of life, brachial plexus injury occurred in the catastrophic bleed cases. Avoiding vessel tearing may have been achieved by first approaching the artery in cases where the humeral shaft lies beneath the coracoid. Early computed tomography angiography with a coordinated orthopedic vascular multidisciplinary approach may facilitate preoperative recognition and management of this uncommon injury.Publication Open Access Assessing unit perspectives on referrals to a regional bone and soft tissue tumour service(Springer Nature, 2026-03-18) Armitage, Jessica; Subudhi, Trisha; Rao, Vijesh; Ashwood, Neil; University Hospitals of Derby and Burton NHS Foundation Trust; University of Leicester; Trauma and Orthopaedics; Medical and Dental; Armitage, Jessica; Rao, Vijesh; Ashwood, NeilPathologies of bone and soft tissues may be complex and heterogeneous; referral patterns influence service efficiency and workflow. This study quantifies regional evidence of referral volume, diagnostic outcomes, and pre-referral imaging pathways from the perspective of referring units. All referrals to a tertiary United Kingdom Midlands National Health Service (NHS) bone and soft tissue service over a 10-year period were retrospectively assessed using a prospectively maintained institutional database. In total, 279 patients were referred for specialist assessment during the study period. Diagnoses were classified as provisional or final, with imaging modalities categorised as first-, second-, or third-line investigations prior to referral in accordance with the order in which they were performed. True malignant bone tumours, as defined by histology, constituted a small proportion of referrals: seven patients (2.5%). Benign bone and soft tissue lesions represented a sizeable proportion of provisional diagnoses: 81 patients (29.0%). Metastatic disease and malignant bone tumours were provisionally diagnosed, more commonly than they were confirmed by specialist assessment: 84 patients (30.1%) provisionally referred, 35 patients (12.5%) confirmed following specialist review. Referral volumes varied across specialties and many patients underwent multiple imaging studies prior to referral. These findings provide baseline observational data from a single regional service and highlight the role of specialist bone and soft tissue tumour centres as important diagnostic triage and risk-stratification services within a landscape of heterogeneous pathology and referral pathways. The identification of malignant disease within a small subset of referrals reinforces the value of early specialist assessment for patients with suspected bone and soft tissue tumours.Publication Open Access Completion of treatment escalation plans and resuscitation discussions in frail and elderly patients with hip fractures(Springer Nature, 2026-03-17) Stonelake, Henry; Ashwood, Neil; University Hospitals of Derby and Burton NHS Foundation Trust; Trauma and Orthopaedics; Medical and Dental; Stonelake, Henry; Ashwood, NeilBackground: Hip fractures disproportionately occur in frail and elderly patients and carry high mortality even with optimal management. The British Orthopaedic Association recommends that all frail and elderly trauma patients have ceilings of treatment (CoTs) and appropriateness of cardiopulmonary resuscitation (CPR) decided pre-operatively. Our hospital documents these treatment escalation plans (TEPs) within the Resuscitation Council UK’s Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms. Methods We sampled the hip fracture population at Burton Hospital orthopaedic ward on random days between October and November 2024. We separately collected data on other patients with a ReSPECT form to see whether omissions on these forms were specific to the hip fracture group or replicated more widely. Results We collected data for 42 patients, including 33 patients admitted with hip fractures and nine non-hip fracture patients. We found that 20 (61%) hip fracture patients had a ReSPECT form that documented the appropriateness of CPR. However, only nine (45%) of these documented an appropriate CoT. This left only nine (27%) hip fracture patients with a full TEP. Out of all decisions documented, 16 (80%) were endorsed by a consultant. In the non-hip fracture group, we found that many ReSPECT forms also lacked a CoT. There was no significant difference in the completion of a CoT on ReSPECT forms between the hip fracture and non-hip fracture groups (p=0.69). Conclusion We found that many patients with a hip fracture did not have a documented recommendation on the appropriateness of CPR, and even fewer had a decision documented on the appropriateness of escalation. This meant that neither area met the standard of 100% set for our audit. This was in part due to the incompletion of the clinical recommendations section on the ReSPECT forms, which we highlight is an often-omitted section in our hospital. Review of the escalation plan within a comprehensive geriatric assessment, and increasing clinician education on TEPs, may help to improve the number of complete treatment escalation plans made.Publication Open Access An analysis of trauma and elective orthopaedic incomes in a UK hospital: a rationale for implementation of ambulatory trauma(Spinger Nature, 2026-01-14) Saxena, Prateek; Amanullah, Niyam; Wilson, Paul; Ashwood, Neil; University Hospitals of Derby and Burton NHS Foundation Trust; University Hospitals of Derby and Burton NHS Foundation Trust; University Hospitals of Derby and Burton NHS Foundation Trust; University of Wolverhampton; Trauma & Orthopaedics; Medical and Dental; Saxena, Prateek; Ashwood, Neil; Amanullah, NiyamIntroduction: In the UK, one-third of orthopaedic departments experience financial losses from surgical interventions, with specialist hospitals experiencing higher deficits due to factors like patient age and injury severity. This study investigates financial modelling and potential changes in care delivery to enhance the regional flow of orthopaedic care throughout the UK, as well as strategies to address this economic disparity. Methods:The study analyzed the impact of various orthopaedic subspecialties on departmental income and loss during the previous financial year (April 2023 to April 2024). The goal was to understand how different care models, including both ambulatory (same-day) and non-ambulatory (inpatient) pathways, influence these financial outcomes. The need for non-ambulatory care increases with patient frailty and age; however, the study suggests that treating fitter trauma patients on an outpatient basis could help offset overall orthopaedic care costs. Results:In the last financial year, the trust encountered 32088 coded episodes, with 1707 trauma and 1275 elective operations. Despite incentivised weekend lists to reduce waiting lists, the demand for trauma care outweighs that for elective care at a local level. Discussion: The government has significantly invested in elective centres designed to perform high-volume, low-risk operations. These initiatives aim to shorten waiting lists and tackle the backlog of orthopaedic care patients that grew rapidly during the COVID-19 pandemic. Organisational care delivery is largely shaped by economic drivers mandated through government policy, rather than being primarily guided by clinical needs. Trauma patients frequently struggle to receive urgent care within specified time frames due to insufficient funding, unlike elective procedures, which face politically driven, rather than clinical, time limits. Conclusions: Implementing ambulatory trauma care can help reduce costs and enhance hospital profitability. This approach ensures that patient flows align with demand and provides a payment structure that supports younger, working-age patients returning to employment, provided the day-case surgery tariff is sufficient to support the development of regional ambulatory trauma units.Publication Open Access Selective Genicular Artery Embolisation for Recurrent Hemarthrosis Following Total Knee Arthroplasty: A Case Report(Springer Nature) Aakanksha, Garlapati; Rasul, Shahmeen; Ashwood, Neil; Hayward, KeithRecurrent hemarthrosis following total knee arthroplasty (TKA) is an uncommon complication, with an incidence of less than 1%. It can lead to pain, swelling, joint stiffness, and functional impairment. Selective genicular artery embolisation (GAE) has emerged as a minimally invasive treatment for managing such cases. We report the case of a 79-year-old female with recurrent atraumatic hemarthrosis of the left knee following TKA, complicated by long-term anticoagulation with Edoxaban for unprovoked pulmonary embolism. Despite multiple aspirations and arthroscopic washouts, symptoms persisted. Angiography revealed synovial hypervascularity, and GAE was performed to reduce bleeding. Although the procedure initially improved symptoms, recurrence occurred while the patient was maintained on full-dose Edoxaban. Following a multidisciplinary review, the anticoagulant dose was reduced, resulting in complete resolution of haemarthrosis. GAE represents an effective, minimally invasive treatment for recurrent hemarthrosis post-TKA. Anticoagulation management and multidisciplinary coordination are essential to balance bleeding risk and thromboembolic protection in such patients.Publication Open Access Weighing the impact of evidence in orthopaedic trauma registries: a systematic review of national and international registry data.(BMJ) George, Akhshay John; Ashwood, Neil; Dekker, Andrew; Crawford, Adrian; Mukherjee, ArnovOBJECTIVES: Worldwide, there are 15 established trauma databases collecting data to better understand the patterns of injury and effectiveness of interventions, but interpreting the information is hampered by the varied approaches. The aim of this study was to determine the impact, practices, evolution in design and methods of analysis that are standardised and comparable within registries. DESIGN: A thematic analysis using a narrative synthesis was used to develop threads for future study and identify the limitations in current practice. DATA SOURCES: PubMed, Ovid, Scopus and EMBASE were searched on the 2 October 2025. At the same time, ChatGPT (Open artificial intelligence) identified the most cited articles in orthopaedic trauma registries, cross-referencing lists as a form of triangulation to aid in snowballing references. ELIGIBILITY CRITERIA: The review included 174 papers from trials and observational studies that analyse data from established trauma orthopaedic registries published in English. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers used standardised methods to search, screen and code included studies assessing the papers using the Strengthening the Reporting of Observational Studies in Epidemiology checklist to assess the observational and cohort studies and the Downs and Black Quality Criteria for the remaining papers. RESULTS: Outcome measures other than mortality are poorly collected, undermining the value of registries. Trauma patients reported considerable impairment 6 and 12 months after injury. Association between level of trauma care and mortality is evident for major trauma populations, but does not hold for general trauma populations. Level I trauma centres produce improved survival in severely injured, but this association could not be proven for non-fatal outcomes in general populations. There is a disparity between resources allocated to save and salvage cases within major trauma units, and hence, routine cases often have lower priority and delayed care. CONCLUSIONS: There is a need to develop a standardised and reproducible method to evaluate data quality in trauma registries. National performance guidelines and trauma centre audits are integral steps towards optimum results. Routine collection of postinjury outcome measures beyond mortality will enable the development of quality improvement metrics that better reflect patient outcomes.Publication Open Access Tailored performance of additively manufactured titanium TPMS bone scaffold(Elsevier) Vance, Aaron; Ashwood, Neil; Arjunan, ArunTriply periodic minimal surfaces (TPMS), exemplified by the Schwarz geometry, provide an optimal platform for bone scaffolds due to their high surface-to-volume ratio, continuous porosity, and bone-analogous mechanical response. Here, titanium TPMS scaffolds were additively manufactured via laser powder bed fusion (L-PBF) with precise control over geometric parameters. A data-driven surrogate model, informed by experimental and numerical analyses, was developed to map the relationship between design variables and mechanical performance. The model enabled the design of scaffolds with tailored stiffness matching that of native bone, while revealing the dominant roles of wall thickness and cell size. Porosity varied from 47 % to 68 %, governed inversely by wall thickness, while elastic modulus scaled from 6 to 24 GPa, driven primarily by wall thickness and secondarily by cell size. Yield and ultimate strengths exhibited strong positive correlations with wall thickness, spanning 240–655 MPa and 320–784 MPa, respectively. This study provides a predictive framework for engineering 3D printed titanium scaffolds with targeted mechanical properties, offering a basis for next-generation load-bearing orthopaedic implants.Publication Open Access Operative Versus Nonoperative Outcomes: A Cohort Study on Distal Biceps Tendon Rupture.(Springer Nature) Dekker, Andrew; Niyam, Amanullah; Ishaq, A; Ashwood, NeilBackground Distal biceps tendon ruptures typically occur in middle-aged men following eccentric loading activities. While surgical repair is common, comparative data on operative versus nonoperative outcomes remain limited. We conducted a retrospective study to compare the outcomes of operative versus nonoperative management in Queen's Hospital Burton. Methods We reviewed the records of 72 patients (52 operative, 20 nonoperative) treated during the period of 2016-2023 for complete distal biceps tendon ruptures. All diagnoses were confirmed clinically and radiologically. Operative management was via a single anterior incision or a modified two-incision technique using cortical button fixation. Complications, range of motion, and return to activity were abstracted from clinical records documented at the time of care. Validated outcome measures, such as the Disabilities of the Arm, Shoulder, and Hand (DASH) and the Mayo Elbow Performance Score (MEPS), were not collected as part of routine care. Results Operative management was associated with a higher rate of complications, including nerve injuries and wound issues, though most patients ultimately regained a full range of motion and function. Nonoperative management resulted in minimal complications, with patients reporting return to their previous activity levels and only minor subjective strength deficits. Overall, operative repair offered greater strength recovery, particularly in supination, but at the cost of increased morbidity, whereas nonoperative management provided excellent functional outcomes with lower risk. Conclusion Nonoperative management appeared to be a reasonable option for selected patients in this cohort. Operative repair is effective but associated with a higher complication rate. Treatment should be individualised, balancing patient activity level, expectations, and risk profile.